Effects of Continuity of Care on Emergency Department Use and Non-urgent Emergency Department Visits among the Elderly in Taiwan

Objectives: To explore the continuity of care in Taiwan, and to examine the association between continuity of care and emergency visits and non-urgent ED visits among the elderly in Taiwan.

Methods: This study used a longitudinal design to examine 2008-2010 claims data capturing health care utilization obtained from the academic database of National Health Research Institute. A total of 21,079 persons aged over 65 years were included in the analysis. The dataset provided information about patients’ physician visits and ED visits. The continuity of care index(COCI) developed by Bice and Boxerman was adopted for this study. Negative binominal regression and logistic regression were used, respectively, to examine the association between COCI and ED visits and non-urgent ED visits while related variables were controlled for in the models.

Results: The average continuity of care score in Taiwan was 0.26. The results from the regression models revealed that, among the 3 COCI groups, people with high COCI made 35.60% fewer ED visits and had reduced odds of being non-urgent ED visits when compared with those with low COCI(OR = 0.57, CI = 0.49–0.65).

Conclusions: As in previous studies, our preliminary findings imply that continuity of care improves healthcare outcome. Improving continuity of care should be an important strategy of future healthcare reform in Taiwan.